Late miscarriage is defined as the spontaneous and involuntary termination of pregnancy that occurs between the 14th and 22nd week of amenorrhea. Causes, symptoms, treatment… Pr Cyril Huissoud, head of the obstetrics gynecology department of the HFME and secretary general of the CNGOF, sheds some light.
If miscarriages occur most often during the first trimester of pregnancy, they can also occur between 12 and 20 weeks of pregnancy, i.e. between 14 and 22 weeks of amenorrheain which case it is a question of late miscarriage.
What is a late miscarriage?
Late miscarriage is termination or expulsion of a pregnancy between the end of the first trimester (14SA) and the beginning of the viability threshold of the fetus (22SA), which corresponds approximately to the fifth month of pregnancy. In the first trimester, we rather speak of early miscarriagewhich is generally linked to an anomaly in the development of the fetus, while beyond the threshold of viability (22SA), we rather speak of fetal death in utero or premature delivery.
What is the percentage of late miscarriages?
Late miscarriages affect 1% of pregnancies. Remember that one in ten women is affected by a miscarriage during her lifetime.
What can cause a late miscarriage?
First of all, you should know that the risk of miscarriage increases with age. Some pregnancies end late for unexplained reasons, but the most likely hypothesis would be a chromosomal abnormality of the embryo. Other factors can be the cause of a late miscarriage: infection, dysfunction of the placenta, malformation of the uterus, abnormality of the uterine cavity, hormonal upheavals or blood coagulation abnormalities. . But the most common cause of late miscarriage with expulsion or threat of expulsion of the fetus, is “a cervico-isthmic open bite, that is, a cervix that is mechanically insufficiently competent and opens too easily under the influence of increased pressure in the uterus . In other words, the cervix is too weak and does not have the necessary capacities to maintain a pregnancy.“, explains Professor Cyril Huissoud.
What are the symptoms of a late miscarriage?
“A late miscarriage or threatened late miscarriage is essentially manifested by heaviness and pain in the stomach, related to the fact that the cervix opened without the patient having had the perception of its contractions”informs the obstetrician-gynecologist. Sometimes the bag of waters breaks, resulting in loss of amniotic fluid and expulsion of the fetus. Bleeding may be associated, but it is not systematic.
“A late miscarriage is mainly manifested by heaviness and pain in the belly”.
Is it possible to miscarry at 4 months? At 6 months?
Beyond the fetal viability threshold of 22 weeks of amenorrhea, we no longer speak of miscarriage but of death in utero or premature delivery.
What is a late silent miscarriage?
Unlike an early miscarriage that bleeds almost all the time, late miscarriage may be silent and not accompanied by any bleeding. Opening the cervix may eventually cause bleeding, but it will never be as heavy as in the first trimester. “The bag of waters can invade the vagina with the fetus which is half in the vagina and half in the uterus. In some cases, late miscarriage is not accompanied by any symptoms, then it is called silent“, details the specialist.
What is the treatment for a late miscarriage?
After 16 weeks of amenorrhea, the curettage by suction is no longer possible. It is then necessary to proceed to a real childbirth. In case of suspicion of cervico-isthmic open bite or in case of history of FCT, cervical cerclage can be done to preserve the next pregnancy. “Regular monitoring, in particular via endovaginal ultrasounds to measure the length of the cervix, will be instituted. Administration of progesterone capsules intravaginally may be recommended to avoid any shortening of the cervix. Indeed, progesterone aims to strengthen the tone of the cervix and limit contractions, thus reducing the risk of premature delivery.“, develops Pr Cyril Huissoud. The CNGOF specifies that, “in the event of a history of FCT after 16 weeks, if the subsequent pregnancy is a singleton pregnancy, it is recommended to perform cerclage only in the event of a short cervix (less than 25 mm) on ultrasound before 24 weeks, because this this reduces the risk of prematurity and perinatal morbidity and mortality”.
Thanks to Pr Cyril Huissoud, head of the obstetrics gynecology department of the HFME and secretary general of the CNGOF